Claudia Khouri Chalouhi1, Federica Vernuccio2, Francesca Rini3, Piergiorgio Duca4, Bruno Tuscano5, Giuseppe Brancatelli6, Angelo Vanzulli1,7. 1. ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy. 2. Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy. federicavernuccio@gmail.com. 3. Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy. 4. 'L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Milan, 20122, Italy. 5. Postgraduation School of Radiodiagnostics, University of Milan, Via Festa del Perdono, 7, Milan, 20122, Italy. 6. Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy. 7. Department of Oncology and Hemato-oncology, University of Milan, Milan, 20122, Italy.
Abstract
OBJECTIVES: The purpose of this study was to compare the performance of gadobenate dimeglumine-enhanced MRI and gadoxetic acid-enhanced MRI in the hepatobiliary phase (HBP) in cirrhotic patients with different degrees of liver dysfunction. METHODS: In this retrospective cross-sectional study, we analyzed the unenhanced phase and the HBP of 131 gadobenate dimeglumine-enhanced MRI examinations (gadobenate dimeglumine group) and 127 gadoxetic acid-enhanced MRI examinations (gadoxetic acid group) performed in 249 cirrhotic patients (181 men and 68 women; mean age, 64.8 years) from August 2011 to April 2017. For each MRI, the contrast enhancement index of the liver parenchyma was calculated and correlated to the Model For End-Stage Liver Disease (MELD) score (multiple linear regression analysis). A qualitative analysis of the adequacy of the HBP, adjusted for the MELD score (logistic regression analysis), was performed. RESULTS: The contrast enhancement index was inversely related (r = - 0.013) with MELD score in both gadoxetic acid and gadobenate dimeglumine group. At the same MELD score, the contrast enhancement index in the gadoxetic acid group was increased by a factor of 0.23 compared to the gadobenate dimeglumine group (p < 0.001), and the mean odds ratio to have an adequate HBP with gadoxetic acid compared to gadobenate dimeglumine was 3.64 (p < 0.001). The adequacy of the HBP in the gadoxetic acid group compared to the gadobenate dimeglumine group increased with the increase of the MELD score (exp(b)interaction = 1.233; p = 0.011). CONCLUSION: In cirrhotic patients, the hepatobiliary phase obtained with gadoxetic acid-enhanced MRI is of better quality in comparison to gadobenate dimeglumine-enhanced MRI, mainly in patients with high MELD score. KEY POINTS: • In cirrhotic patients, the adequacy of the hepatobiliary phase with gadoxetic acid-enhanced MRI is better compared to gadobenate dimeglumine-enhanced MRI. • Gadoxetic acid-enhanced MRI should be preferred to gadobenate dimeglumine-enhanced MRI in cirrhotic patients with MELD score > 10, if the hepatobiliary phase is clinically indicated. • In patients with high MELD score (> 15), the administration of the hepatobiliary agent could be useless; even though, if it is clinically indicated, we recommend to use gadoxetic acid given the higher probability of obtaining clinically relevant information.
OBJECTIVES: The purpose of this study was to compare the performance of gadobenate dimeglumine-enhanced MRI and gadoxetic acid-enhanced MRI in the hepatobiliary phase (HBP) in cirrhotic patients with different degrees of liver dysfunction. METHODS: In this retrospective cross-sectional study, we analyzed the unenhanced phase and the HBP of 131 gadobenate dimeglumine-enhanced MRI examinations (gadobenate dimeglumine group) and 127 gadoxetic acid-enhanced MRI examinations (gadoxetic acid group) performed in 249 cirrhotic patients (181 men and 68 women; mean age, 64.8 years) from August 2011 to April 2017. For each MRI, the contrast enhancement index of the liver parenchyma was calculated and correlated to the Model For End-Stage Liver Disease (MELD) score (multiple linear regression analysis). A qualitative analysis of the adequacy of the HBP, adjusted for the MELD score (logistic regression analysis), was performed. RESULTS: The contrast enhancement index was inversely related (r = - 0.013) with MELD score in both gadoxetic acid and gadobenate dimeglumine group. At the same MELD score, the contrast enhancement index in the gadoxetic acid group was increased by a factor of 0.23 compared to the gadobenate dimeglumine group (p < 0.001), and the mean odds ratio to have an adequate HBP with gadoxetic acid compared to gadobenate dimeglumine was 3.64 (p < 0.001). The adequacy of the HBP in the gadoxetic acid group compared to the gadobenate dimeglumine group increased with the increase of the MELD score (exp(b)interaction = 1.233; p = 0.011). CONCLUSION: In cirrhotic patients, the hepatobiliary phase obtained with gadoxetic acid-enhanced MRI is of better quality in comparison to gadobenate dimeglumine-enhanced MRI, mainly in patients with high MELD score. KEY POINTS: • In cirrhotic patients, the adequacy of the hepatobiliary phase with gadoxetic acid-enhanced MRI is better compared to gadobenate dimeglumine-enhanced MRI. • Gadoxetic acid-enhanced MRI should be preferred to gadobenate dimeglumine-enhanced MRI in cirrhotic patients with MELD score > 10, if the hepatobiliary phase is clinically indicated. • In patients with high MELD score (> 15), the administration of the hepatobiliary agent could be useless; even though, if it is clinically indicated, we recommend to use gadoxetic acid given the higher probability of obtaining clinically relevant information.
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